Good News About Miscarriage

A friend and I used to discuss whether, in terms of potential fertility challenges, is it preferable to have trouble getting pregnant or to have trouble staying pregnant. With two miscarriages each, we were in the category of having trouble staying pregnant.

After I miscarried, I got conflicting advice about when to try to conceive again. Conventional wisdom had been that women should wait six months after miscarrying before trying to conceive again. Some doctors still advised this practice, but others said that waiting had no merit. I was also receiving acupuncture from practitioners who believed in waiting.

Does six months seem like a long wait to you? It felt like an unbearable hiatus to me. Six months of feeling sad and wondering how my next pregnancy would fare. Screw that, I thought, let’s move on and try again. Plus, at 34, I was concerned about my age-related fertility decline. (Now that I’m researching a book about this subject I realize that I should not have worried so much about this.)

Wanting to make my decision based on scientific evidence, I obsessively researched miscarriages – the causes, the frequency, the extent to which one marriage predicted future pregnancy outcome, and how to proceed after having a miscarriage. This last point really stressed me out. Overall, the research was lacking. One exception was the book Coming to Term by Jon Cohen, but in some ways this book just highlighted the weakness of existing data.

Remembering that time, I was really interested to read two recent studies. They brought good news.

Dempsey et al followed a group of 42 women who had had three or more miscarriages previously and found that 74% of them got pregnant the next time around and had healthy babies. The women were age 30-42, and the median number of previous miscarriages was four. Eleven of the women had a miscarriage or nonviable pregnancy during the study, but six of these have had healthy pregnancies since the study ended. The authors wrote, in a conclusions statement quite cheery for a journal article, “Our study confirms the reassuring prognosis for achieving a live birth in the unexplained recurrent miscarriage population with a very low incidence of adverse events with the majority delivering appropriately grown fetuses at term.”

They did not answer the question about optimal time from conception to miscarriage, but Kaandorp and some other researchers from the Netherlands provided some insights on this. They enrolled a group of women with two or more unexplained miscarriages and followed them over time, which is methodologically much more accurate than many previous studies, which asked women to recall past events. The Dutch researchers found that women with multiple past unexplained miscarriages got pregnant about as quickly as other women – 56% were pregnant by six months, 74% after a year, and 86% after two years. (And these numbers are pretty consistent with Sharon’s previous post about how long it takes to conceive.)

Although this does not prove that waiting six months to conceive has benefit, it suggests that most women do not wait, and usually their pregnancies are fine.

That is certainly not to say miscarriage is no big deal. It can be physically and emotionally taxing, especially when women experience more than one miscarriage in a row without any medical explanation. (This happens to 1-5% of women.) Having another baby does not feel like a replacement for the fetus that was lost.

However, these studies provide further evidence that past miscarriage should not be allowed to influence a woman’s future expectations. That’s certainly true for me and my friend – now we each have had two healthy pregnancies resulting in four wonderful children.

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I am happy for women of todayy. I am now 55 and yet not completely over my miscarriages and unsuccessful fertility treatments for 10 years in the 80s and 90s. Different times and medical realities. Even with a good life and stepchildren and grandchildren, there's still pain.